How successful are first-attempt insertion rates in peripheral veins?
Peripheral venous access is routinely required in healthcare settings around the world, yet failure rates for first-time peripheral cannulation attempts are surprisingly high. Studies conducted among adults in emergency settings reveal up to one quarter – 26% – of first-insertion attempts fail (Lapostolle et al. 2007). Findings for pediatric patients are even more alarming: up to half – 51% – of first-insertion attempts fail across diverse settings (Hess 2010).
Multiple physical factors are behind these figures. In particular are those that contribute to difficult venous access (DVA) patient profiles, such as veins that are hard to visualize or palpate, darker skin tones, extreme body weights (both high and low), young or old age, and certain medical conditions. For example, Carr et al. recorded a 14% failure rate among adults in a study in an Australian emergency setting (2015). However, most of the patients who took part had Caucasian skin tones and seemingly normal body weights. Failure rates jumped to 27% for those patients without visible veins, 40% for patients without palpable veins, and 60% for patients who were emaciated. The authors included age, body size, and the presence of visible and palpable veins as “significant predictors of first-time successful insertion” (Carr et al. 2015, p. 4).
Data collected during a 20-month study at a U.S. pediatric hospital certainly underscores high first-attempt failure rates with children (Lininger 2003). Of the 249 pediatric patients between the ages of three days and 20 years studied, 47% endured a first-attempt failure. On average, it took practitioners 2.35 tries to gain peripheral venous access with these young patients.
Though her own study did not involve IV nurse specialists, Lininger noted that much of the published literature on pediatric success rates is tied to such specialists. She also noted that practitioner experience is often linked to success rates and hypothesized that IV nurse specialists may be more experienced with peripheral IV insertions. Interestingly, Carr et al. pointed to both practitioner experience and a practitioner’s “increased perception of the likelihood of success” as statistically significant contributors to the attainment of first-attempt insertion (2015, p. 7).
In another U.S.-based study, researchers focused on success rates of ultrasound-guided peripheral vein cannulation in adult DVA patients who had already experienced two failed attempts and presented “no other visible vein to use for further attempts” (Chinnock, Thornton & Hendey 2007, p. 405). These patients had been classified as DVA due to existing medical conditions, IV drug abuse, obesity, or a combination of such factors. Researchers reported cannulation success for 63%, or 63 of 100 patients; of these, 83% experienced successful ‘first’ insertion attempts. However, it must be stressed that the first attempt in this study was in reality the third attempt for these DVA patients. It is also important to note that while ultrasound devices available to specialists can contribute to insertion success, such devices are cost-prohibitive and unavailable to most generalists.
First-attempt failure rates are especially worrisome considering the sheer volume of patients at risk. Based on a previous publication (Lamperti & Pittiruti 2013) and information on hospital admissions (Winter 2015), it is estimated that over 10 million hospitalized patients – adult and pediatric – required venous access for IV therapy during the 2014-2015 financial year in England alone. Chinnock, Thornton and Hendey (2007, p. 401) talked of unsuccessful peripheral IV attempts resulting in “lost nursing and physician time”. Lininger (2003, p. 301) noted practitioner success and number of insertion attempts influence patient satisfaction, and said “cost-effectiveness as well as patient satisfaction should go hand in hand”. Globally, the cost of failure is likely incalculable, but there is no question that healthcare providers and their patients are paying heavy prices in terms of lost time, money and satisfaction.
Revolutionizing venous access
The Veinplicity venous access device directly addresses the factors leading to cannulation failures identified in the studies referenced above. Through gentle but rapid stimulation, Veinplicity causes a marked physiological change: larger, more rigid and more stable veins. It is the only venous access device to physiologically expand and stabilize veins, which is critical for attaining first-attempt insertion success.
Across population groups, Veinplicity gives practitioners greater scope for more veins in practical locations. Veinplicity can improve first-attempt success rates because it increases the diameter of the vein lumen by up to 50%. Engorged veins remain palpable for approximately 20 minutes after stimulation, allowing practitioners to use both hands to gain successful venous access. Successful first attempts boost patient and practitioner satisfaction, contributing to practitioners’ higher expectations for success.
Join the revolution and help us make difficult venous access history.
Carr, PJ, Rippey, JCR, Budgeon, CA, Cooke, ML, Higgins, N & Rickard, CM 2015, ‘Insertion of peripheral intravenous cannulae in the Emergency Department: factors associated with first-time insertion success’, The Journal of Vascular Access, vol. 17, no. 2, pp. 182-190.
Chinnock, B, Thornton, S & Hendey, GW 2007, ‘Predictors of success in nurse-performed ultrasound-guided cannulation’, The Journal of Emergency Medicine, vol. 33, no. 4, pp. 401-405.
Hess, HA, 2010, ‘A biomedical device to improve pediatric vascular access success’, Pediatric Nursing, vol. 36, no. 5, p. 259.
Lamperti, M & Pittiruti, M, 2013, ‘Difficult peripheral veins: turn on the lights’, British Journal of Anaesthesia vol. 110, no. 6, pp. 888–91.
Lapostolle, F, Catineau, J, Garrigue, B, Monmarteau, V, Houssaye, T, Vecci, I & Adnet, F 2007, ‘Prospective evaluation of peripheral venous access difficulty in emergency care’, Intensive Care Medicine, vol. 33, no. 8, pp. 1452-1457.
Lininger, RA 2003, ‘Pediatric peripheral IV insertion success rates’, Pediatric Nursing, vol. 29, no. 5, pp. 351-354.
Winter, J, 2015, ‘Hospital Episode Statistics’, Admitted Patient Care, England – 2014-2015. Hos. Epis. Stat.